Evolution and Impact of Managed Care in the Heath Care Industry
Case management has overtaken normal medical procedure in the recent past, since stakeholders are aiming at maximizing the quality of healthcare and minimizing costs at the same time. Case management has therefore evolved due to changing patient expectations, the number of people being served and the scope of diseases covered. Lifestyle change has also caused a shift in emerging conditions and illnesses. Health facilities have had to re-adjust their systems, such that they can accommodate these schemes. A third party can now pay a patient's bill, thus health facilities have had to link the two. Case management has revolutionized the type of care patients with chronic conditions receive. They can now receive treatment and assessment from the comfort of their homes without having to travel to hospital. According to Leyerle (2016) c urrently, three-quarters of Americans are enrolled in managed care plans, as long as they have an insurance cover. This amounts to around 160 million Americans. Given that in 1994 there was a failure in the United States healthcare reform; patients have also become skeptical of healthcare covers. This has however been overcome by improved patient outcomes that have come along with managed care.
Managed care has brought a revolution in the healthcare industry. The most evident being improved patient output. Health facilities also find it easier to deliver quality medical services, since all processes are integrated and controlled at the hospital (Huber, 2017). An integration of these two outcomes have improved the scene in the medical world, and healthcare generally. Patients can comfortably get treatment without having to worry about bills, movement, and post-treatment care. All these are encompassed in the case management package.
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Case Management and the Nursing Process
Case management is a dimension that has been adopted by health providers in the recent past as a way of minimizing healthcare cost, yet giving patients the best service. An agency, organization or individual takes up the responsibility of paying for the human services and medical resources used in the healthcare of the client (Huber, 2017). This is common in insurance companies, welfare societies, among others. Nursing, on the other hand, has been in existence since time immemorial. Nursing started with home-based care using locally available materials as medication. However, these two have a number of similarities. Case management is a part of nursing since it is done by nurses. It cannot be separated from nursing. Case managers are nurses who work closely with the family of the clients, customizing their services to fit the specific client (Huber, 2017). This is the same thing that happens in hospital, with the difference being that most case managers visit their patients at home since most have chronic diseases. While nurses primarily admit patients, give care them the necessary medical care, and facilitate their discharge, case management entails screening, assessment, planning, coordination of patient care, conducting follow up, communication after discharge, and evaluation of expenses.
Patient outcomes have improved since service is personalized. Case management manages the client’s affairs right from assessing the condition, to post-treatment management. The patient can, therefore, receive the best quality of healthcare with minimal hassle and cost (Wallace et al ., 2015). In this way, the patient’s expectations are likely to be met, thus better patient output.
References
Huber, D. (2017). Leadership and Nursing Care Management-E-Book . Elsevier Health Sciences.
Leyerle, B. (2016). The private regulation of American health care . Routledge.
Wallace, E., Salisbury, C., Guthrie, B., Lewis, C., Fahey, T., & Smith, S. M. (2015). Managing patients with multimorbidity in primary care. Bmj , 350 , h176.
